Interpretations
The observed NAFLD prevalence of 51.3% in early pregnancy seems higher
than the previously reported values for Sri Lanka (18.2%)20, Canada (17.6%) 25, Korea
(18.4%) 11,38, and USA
(14.3-16.7%)10. However, the prevalence in this study
is not significantly different from the comparison group of non-pregnant
reproductive age women from same geographical location. Irrespective of
pregnancy, this high prevalence of fatty liver in this rural young woman
(mean age 28.8 years) needs to be taken seriously as a major predicter
of future NCDs.
NAFLD is considered as a hepatic manifestation of metabolic syndrome39. According to the multiple hit hypothesis proposed
by Elenza et al. increasing oxidative stress, inflammation, endothelial
dysfunction can lead to development of NAFLD 40. These
underlying issues leading to NAFLD may have other effects on the mother
and child which has not been fully evaluated yet. One of the most
important findings of this study was the unprecedented observation of FL
as a major risk factor for mid-pregnancy miscarriages with an odds ratio
of 8.4. Liu Y et al. showed that abortions in women with NAFLD were
higher than those without NAFLD (72.4% vs. 69.3%, age-adjusted
P=0.001) 41. The pathophysiology behind this
association is still not very clear. However, we can assume that the
oxidative stress, endothelial damage and inflammation may predispose to
development of early pregnancy loss 40. This
observation with high effect size is of significant public health
importance in predicting mid-trimester miscarriages and probably
formulating new guidelines for pregnancy care programmes.
Current evidence on diabetes clearly shows that South Asians are at an
increased risk of all metabolic derangements, including NAFLD, DM and
GDM 42. Combining this knowledge with public health
service provisions could be a practical and comprehensive approach in
pregnancy care programmes. USS has been used for many years for
pregnancy care, especially in the first trimester, as a “dating scan”.
A simple added step in dating scans to screen for fatty liver during
pregnancy may show the risk of developing hyperglycaemia and
mid-pregnancy miscarriage. Our study shows that NAFLD is a better
predictor of these conditions than the traditional “risk factors”
considered in pregnancy. Beyond pregnancy, the diagnosis of NAFLD in
pregnant women would be an early life opportunity to screen for fatty
liver to prevent future non-communicable diseases.